WordNet

(mechanics) the equal and opposite force that is produced when any force is applied to a body; "every action has an equal and opposite reaction"
a response that reveals a persons feelings or attitude; "he was pleased by the audiences reaction to his performance"; "John feared his mothers reaction when she saw the broken lamp"
a bodily process occurring due to the effect of some antecedent stimulus or agent; "a bad reaction to the medicine"; "his responses have slowed with age" (同)response
doing something in opposition to another way of doing it that you dont like; "his style of painting was a reaction against cubism"
an idea evoked by some experience; "his reaction to the news was to start planning what to do"
extreme conservatism in political or social matters; "the forces of reaction carried the election"

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{名}(…に対する)『反応』《+『to』+『名』》 / 〈U〉(…に対する)(政治的・社会的な)『反動』,逆コース《+『against』+『名』》 / 〈U〉〈C〉化学反応,化学変化 / 〈U〉〈C〉(物理学で)反作用

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/02/18 20:29:41」(JST)

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The Jarisch-Herxheimer reaction is a reaction to endotoxins released by the death of harmful organisms within the body.

Presentation[edit]

It resembles bacterial sepsis and can occur after initiation of antibacterials, such as penicillin or tetracycline, for the treatment of louse-borne relapsing fever (80-90% of patients) and in tick-borne relapsing fever (30-40%). An association has been found between the release of heat-stable proteins from spirochetes and the reaction. Typically, the death of these bacteria and the associated release of endotoxins or lipoproteins occurs faster than the body can remove the substances. It usually manifests within a few hours of the first dose of antibiotic as fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, vasodilation with flushing, myalgia (muscle pain), exacerbation of skin lesions and anxiety. The intensity of the reaction indicates the severity of inflammation. Reaction commonly occurs within two hours of drug administration, but is usually self-limiting.

Treatments[edit]

Prophylaxis and treatment with an anti-inflammatory agent may stop progression of the reaction. Oral aspirin every four hours for 1–2 days, or 60 mg of prednisone orally or intravenously has been used as an adjunctive treatment^{[citation needed]}. However, steroids are generally of no benefit. Patients must be closely monitored for the potential complications (collapse and shock) and may require i.v. fluids to maintain adequate blood pressure. If available, meptazinol, an opioid antagonist, should be administered to reduce the severity of the reaction. Anti TNF-a may also be effective.^{[citation needed]}

Etiologies[edit]

The Jarisch-Herxheimer reaction is classically associated with penicillin treatment of syphilis. Duration in syphilis is normally only a few hours. The reaction is also seen in other diseases caused by spirochetes, such as borreliosis (Lyme disease and tick-borne relapsing fever) and leptospirosis, and in Q fever.^[1] Similar reactions have also been reported to occur in bartonellosis (including cat scratch disease),^[2]^[3] brucellosis,^[4] typhoid fever,^[5] and trichinosis.^[6]

Pathophysiology[edit]

The Herxheimer reaction has shown an increase in inflammatory cytokines during the period of exacerbation, including tumor necrosis factor alpha, interleukin-6 and interleukin-8.^[7]^[8]

History[edit]

Both Adolf Jarisch,^[9] an Austrian dermatologist, and Karl Herxheimer,^[10] a German dermatologist, are credited with the discovery of the Jarisch-Herxheimer reaction. Both Jarisch and Herxheimer observed reactions in patients with syphilis treated with mercury. The reaction was first seen following treatment in early and later stages of syphilis treated with Salvarsan, mercury, or antibiotics. It is seen in 50% of patients with primary syphilis and about 90% of patients with secondary syphilis.^[1]

References[edit]

^ ^a ^b Loscalzo, Joseph; Fauci, Anthony S.; Braunwald, Eugene; Dennis L. Kasper; Hauser, Stephen L; Longo, Dan L. (2008). Harrison's Principles of Internal Medicine. McGraw-Hill Medical. pp. 1048–67. ISBN 0-07-146633-9.
^ Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D (June 2004). "Recommendations for treatment of human infections caused by Bartonella species". Antimicrob Agents Chemother 48 (6): 1921–33. doi:10.1128/AAC.48.6.1921-1933.2004. PMC 415619. PMID 15155180.
^ Koehler JE; Duncan LM (September 29, 2005). "Case records of the Massachusetts General Hospital. Case 30-2005. A 56-year-old man with fever and axillary lymphadenopathy". New England Journal of Medicine 353 (13): 1387–94. doi:10.1056/NEJMcpc059027. PMID 16192484.
^ Madkour MM (2003). "Brucellosis". In D. A. Warrell, Timothy M. Cox, John D. Firth. Oxford Textbook of Medicine. Oxford: Oxford University Press. p. 545. ISBN 0-19-262922-0.
^ Keith Parker; Laurence Brunton; Goodman, Louis Sanford; Donald Blumenthal; Iain Buxton (2008). "Protein synthesis inhibitors and miscellaneous antibacterial agents". Goodman & Gilman's manual of pharmacology and therapeutics. McGraw-Hill Medical. p. 768. ISBN 0-07-144343-6.
^ Grove DI (2003). "Nematode infections of lesser importance". In D. A. Warrell, Timothy M. Cox, John D. Firth. Oxford Textbook of Medicine. Oxford: Oxford University Press. p. 809. ISBN 0-19-262922-0.
^ Vidal V, Scragg IG, Cutler SJ, et al. (December 1998). "Variable major lipoprotein is a principal TNF-inducing factor of louse-borne relapsing fever". Nat. Med. 4 (12): 1416–20. doi:10.1038/4007. PMID 9846580.
^ Kaplanski G, Granel B, Vaz T, Durand JM (July 1998). "Jarisch-Herxheimer reaction complicating the treatment of chronic Q fever endocarditis: elevated TNFalpha and IL-6 serum levels". J. Infect. 37 (1): 83–4. doi:10.1016/S0163-4453(98)91120-3. PMID 9733392.
^ Jarisch A (1895). "Therepeutische Versuche bei Syphilis". Wien Med Wochenschr 45: 721–42.
^ Herxheimer K, Krause D (1902). "Ueber eine bei Syphilitischen vorkommende Quecksilberreaktion". Deutsch Med Wochenschr 28 (50): 895–7. doi:10.1055/s-0028-1139096.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 回帰熱の臨床的特徴および管理 clinical features and management of relapsing fever
2. 早期梅毒の病因、臨床症状、および治療 pathogenesis clinical manifestations and treatment of early syphilis
3. ライム病の治療 treatment of lyme disease
4. HIV感染患者における梅毒の治療および予防 treatment and prevention of syphilis in the hiv infected patient
5. 妊娠中の梅毒 syphilis in pregnancy

English Journal

Elevated CSF Cytokines in the Jarisch-Herxheimer Reaction of General Paresis.

Davis LE, Oyer R, Beckham JD, Tyler KL.SourceDepartment of Neurology Service, New Mexico VA Health Care System, Albuquerque.
JAMA neurology.JAMA Neurol.2013 Aug 1;70(8):1060-4. doi: 10.1001/jamaneurol.2013.2120.
IMPORTANCE The Jarisch-Herxheimer reaction (JHR) is a well-recognized transient worsening of signs and symptoms occurring soon after the first dose of an appropriate antibiotic for several spirochetal infections. The pathogenesis of this reaction is poorly understood. In this case study of cerebrosp
PMID 23732875

The Jarisch-Herxheimer reaction: Revisited.

Belum GR, Belum VR, Chaitanya Arudra SK, Reddy BS.SourceSkin & VD Clinic, Hyderabad, AP, India. Electronic address: drgeetanjali@gmail.com.
Travel medicine and infectious disease.Travel Med Infect Dis.2013 Jul-Aug;11(4):231-7. doi: 10.1016/j.tmaid.2013.04.001. Epub 2013 Apr 28.
The Jarisch-Herxheimer reaction (JHR) is a transient immunological phenomenon seen commonly in patients during treatment for syphilis, and it manifests clinically with short-term constitutional symptoms such as fever, chills, headache and myalgias, besides exacerbation of existing cutaneous lesions.
PMID 23632012

Japanese Journal

Neurosyphilis Mimicking Ramsay Hunt Syndrome

Journal of Nippon Medical School 82(5), 254-256, 2015
NAID 130005108931

Neurosyphilis Is a Long-forgotten Disease but Still a Possible Etiology for Dementia

Internal Medicine 54(21), 2769-2773, 2015
NAID 130005106612

症例抗生剤治療によって精神症状が可逆的であった神経梅毒の1例

精神科 25(3), 356-362, 2014-09
NAID 40020189494

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リンク元	「ヤーリッシュ・ヘルクスハイマー反応」
関連記事	「reaction」「Herxheimer reaction」

「ヤーリッシュ・ヘルクスハイマー反応」

Herxheimer reaction
	Classification and external resources
ICD-10	T78.2
ICD-9	995.0
DiseasesDB	32939

　　[★]

英: Jarisch-Herxheimer reaction
同: ヘルクスハイマー反応 Herxheimer reaction、ヤーリッシュ-ヘルクスハイマー反応 Jarisch-Herxheimer反応、Jarisch-Herxheimer現象、ヤーリッシ・ヘルクスハイマー反応

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ヤーリッシ・ヘルクスハイマー反応 : 約 13 件
ヤーリッシュ・ヘルクスハイマー反応 : 約 6,270 件

抗生剤投与により生じる発熱(38℃以上)、頭痛、悪寒、血圧低下、呼吸促迫などの全身症状
病原菌が急激に死滅したための反応
梅毒と回帰熱の治療で見られる

梅毒

第二期で多い(文献によっては第一期と第二期に多いという記載有り)
ペニシリン治療を開始して2-4時間後に現れる

「reaction」

　　[★]

反応

関: react、respond、response、responsive

「Herxheimer reaction」

　　[★] ヘルクスハイマー反応

[Harrison-1] Loscalzo, Joseph; Fauci, Anthony S.; Braunwald, Eugene; Dennis L. Kasper; Hauser, Stephen L; Longo, Dan L. (2008). Harrison's Principles of Internal Medicine. McGraw-Hill Medical. pp. 1048–67. ISBN 0-07-146633-9.

[2] Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D (June 2004). "Recommendations for treatment of human infections caused by Bartonella species". Antimicrob Agents Chemother 48 (6): 1921–33. doi:10.1128/AAC.48.6.1921-1933.2004. PMC 415619. PMID 15155180.

[3] Koehler JE; Duncan LM (September 29, 2005). "Case records of the Massachusetts General Hospital. Case 30-2005. A 56-year-old man with fever and axillary lymphadenopathy". New England Journal of Medicine 353 (13): 1387–94. doi:10.1056/NEJMcpc059027. PMID 16192484.

[4] Madkour MM (2003). "Brucellosis". In D. A. Warrell, Timothy M. Cox, John D. Firth. Oxford Textbook of Medicine. Oxford: Oxford University Press. p. 545. ISBN 0-19-262922-0.

[5] Keith Parker; Laurence Brunton; Goodman, Louis Sanford; Donald Blumenthal; Iain Buxton (2008). "Protein synthesis inhibitors and miscellaneous antibacterial agents". Goodman & Gilman's manual of pharmacology and therapeutics. McGraw-Hill Medical. p. 768. ISBN 0-07-144343-6.

[6] Grove DI (2003). "Nematode infections of lesser importance". In D. A. Warrell, Timothy M. Cox, John D. Firth. Oxford Textbook of Medicine. Oxford: Oxford University Press. p. 809. ISBN 0-19-262922-0.

[7] Vidal V, Scragg IG, Cutler SJ, et al. (December 1998). "Variable major lipoprotein is a principal TNF-inducing factor of louse-borne relapsing fever". Nat. Med. 4 (12): 1416–20. doi:10.1038/4007. PMID 9846580.

[8] Kaplanski G, Granel B, Vaz T, Durand JM (July 1998). "Jarisch-Herxheimer reaction complicating the treatment of chronic Q fever endocarditis: elevated TNFalpha and IL-6 serum levels". J. Infect. 37 (1): 83–4. doi:10.1016/S0163-4453(98)91120-3. PMID 9733392.

[9] Jarisch A (1895). "Therepeutische Versuche bei Syphilis". Wien Med Wochenschr 45: 721–42.

[10] Herxheimer K, Krause D (1902). "Ueber eine bei Syphilitischen vorkommende Quecksilberreaktion". Deutsch Med Wochenschr 28 (50): 895–7. doi:10.1055/s-0028-1139096.

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Jarisch-Herxheimer reaction